Carb Counting and the Food Exchange System

Talk to your doctor about whether counting carbs or following the food-exchange system is right for you.

Q: My doctor told me I need to start counting my carbs. How does it work, and is it different from the food-exchange system?

A: People with diabetes are sometimes told they need to count carbs or follow a food-exchange system to standardize their diets. Counting carbs is particularly important for people who take insulin because their dosage is dependent on the amount of carbohydrate they need to offset. They determine the number of carbs they will eat in a particular meal, calculate the amount of insulin they will need to clear those carbs from their blood, then give themselves an injection (or program the amount into their insulin pump). Every “portion” of food in a carb-counting list is equal to 15 grams of carbohydrate — including grains, fruits, dairy products, and starchy vegetables. All you need to know is that every 15 grams of carbohydrate counts as 1 carb choice. For example, one medium apple = 15 grams of carbs = 1 portion. Some doctors and diabetes educators instruct their patients to either count total carb grams or count the number of carb portions. If you are a carb counter, look for total carbohydrate grams on the Nutrition Facts panel of the meals in my Recipe Index.

The food-exchange system organizes foods according to their nutritional content: Starch, Fruit, Vegetable, Fat-Free/Reduced-Fat Milk (including milk and yogurt), Very Lean Meat, Lean Meat, Medium-Fat Meat, High-Fat Meat, and Fat. If your doctor has instructed you to follow the exchange system, then follow those recommendations. For type 2 diabetes sufferers who do use the food-exchange system, I've included the exchange breakdown for all of my best Recipes for Type 2 Diabetes.